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I am thrilled to share that I am now an in-network provider with Aetna and its subsidiaries. Aetna members are eligible for up to six lactation consults, with no out-of-pocket costs.

While I am happy to be park of the insurance network, I know many of my clients, and many of you out there, are members of other insurance providers. So what does that mean for you? Can you get your lactation consult covered by insurance?

For many new parents, having access to a consult with an IBCLC (International Board Certified Lactation Consultant) is a crucial step in continuing their breastfeeding journey. Several years ago, breastfeeding support, supplies, and counseling were added to the Affordable Care Act. This change in insurance law has made it possible for more parents to get the care they need, however, there are some bumps in the road and coverage is not always available. Understanding how lactation care and insurance intertwine can be confusing, so hopefully I can shed some light on the issues and provide not only resources for getting your consult covered, but also an inside look into the issues facing IBCLCs.

General coverage - While the Affordable Care Act did place lactation coverage into law, there are many companies and plans that are exempted from required coverage, or who have found loopholes around that coverage. They also vary in how much they will cover, and by whom. Some people are able to see an in-network provider, others are are able to get their consult completely reimbursed, and others are reimbursed for some of the cost. Call your own insurance company before seeing a lactation consultant so that you are aware of the coverage extended to you.

In-Network Providers - Each insurance company creates its own rules about how it will credential providers to be in-network with their company. Some allow all IBCLCs to apply, while others require another license, such as RN or LPN. Some companies place a cap on the number of in-network IBCLC providers in a geographic region. If the IBCLC you work with is not in-network, it may due to the limits of the insurance provider.

Remuneration - Just as coverage and network status are governed by each company, so is the payment extended to the IBCLC. We, as IBCLCs, often feel a calling to assist new families with lactation care. We believe in empowering families to continue their breastfeeding journeys as they see fit. It is often a passion, not just a job. That passion is also a way that we financially support our own families. Some insurance companies provide scant remuneration, which can vary across geographic regions. For some IBCLCs, if they were in-network, the amount of remuneration may not allow them to financially support their own families, thus prohibiting them from providing the much-needed lactation support to other families. They may choose to remain out-of-network in order to continue providing care.

Reimbursement- Since the rules are so different across companies, and even within branches of each company, I always suggest that my clients call their insurance companies to discuss what will be covered, and how much will be reimbursed. Most of my clients are reimbursed for some or all of the consult fee. I, and most other IBCLCs, provide each client with what is called a superbill (receipt with insurance codes) that can be sent to an insurance company for reimbursement. We encourage you to submit it, and re-submit if you run into issues receiving reimbursement.

As previously mentioned, if you are unsure of the coverage extended to you, call your insurance company, and reach out to a local IBCLC for guidance. The insurance market is ever-changing. While we don’t know what changes will unfold in the next few years, IBCLCs will continue to promote lactation coverage for all families to ensure equitable care for everyone.